The knowledge you take with you into your USMLE Step 1 exam draws on many months of medical school studying and USMLE-specific preparation. Thus the last few days before your exam represent only a small fraction of the total time you’ll spend preparing for Step 1. Some will say that the hard work is done by this point and that it’s impossible to “cram” for an exam of this size. However, it’s my belief (and my experience) that these last few days are especially important, and that significant improvements can still be made in the time just before your exam.
This is an outline of how I approached the last three days before my Step 1 exam. Using this method I was able to review large amounts of material in a short amount of time and get a last-minute 14-point bump in my score.
My Timeline: 8 Days Before My Exam – I scored a 242 on NBME 19. 5 Days Before – I finished UWorld. This was my first pass of this question bank, though I’d already gone through Kaplan earlier in the year. 4 Days Before – I took NBME 17 and scored a 240, approximately the same score as I’d received four days prior.
Real Deal - I scored a 254 on Step 1.
My Strategy: The goal of this approach is to review as much material as possible in a way that will be useful on test day. The focus was to refresh on topics that I had already learned but had not seen in some time, and avoid that tip-of-my-tongue feeling during my exam, where I knew I had seen a concept but wasn't familiar enough with it to answer the question correctly. Essentially I was going after things that I could easily bring back to the surface of my memory, to avoid missing “easy” points. There were some facts I had struggled to commit to memory all year (read: everything about worms), and I decided these were mostly lost causes at this point.
It’s common for students to go over previously used or incorrect questions for their final review. This can be inefficient because you must spend time reading the stem and then additional time skimming the explanation for anything you’d like to go over. Most of your time is spent sifting, rather than learning. You also have limited control over what questions appear. You can choose pulmonary physiology, for example, but you cannot choose to review a specific pulmonary physiology concept.
I instead used a mix of First Aid and UWorld to review specific topics. The condensed list of facts in First Aid is perfect for rapid review and easily allows you to skip material you already know. I divided the chapters I wanted to go through across three days and did not review anything I’d already seen within the last two weeks.
As I went through First Aid, first, I read through the information in each box or diagram, as well as any annotations I had written. I tried to be quick with familiar topics so that I could spend a bit more time reviewing areas I was less comfortable with. Second, I clarified any areas of confusion or misunderstanding, without nitpicking or getting caught on details. I looked up any words that were unfamiliar, and related concepts I had forgotten. Most of these clarifications were done through quick Google searches or references to other portions of First Aid. I also referenced Sketchy videos occasionally, and re-watched a select few I thought would be especially helpful given the facts I had been struggling to remember the most.
I then took a moment to reflect and be sure I had a clear understanding of what a question about each disease would look like. Did I know what a typical stem about this patient would look like? Was I comfortable with the euphemisms and code words (ex: “large, globular uterus” for adenomyosis vs “firm, irregular uterus” for fibroids) test makers like to use to signify particular diseases? Did I know how to distinguish it from diseases very similar to it? Being able to answer these questions about your knowledge is an important skill, and something I think can be developed by practicing often (which is another topic altogether). If the answer was "no" to any of the above questions, I used the UWorld search function to look up an example of that topic. I didn’t do the question but instead used UWorld as a textbook-like reference. If I needed to see a stem, I read through a few question stems until I felt comfortable. If I wanted to distinguish two similar diseases, I found a question with both as answer choices and read the relevant wrong answer. As soon as I was satisfied, I moved on in First Aid to the next topic.
In this way, I was ultimately able to review about 2/3 of First Aid over the course of three days. I finished studying at around 4 PM the night before my exam, which gave me enough time to rest so I’d be fresh the next day. I spent the rest of the evening buying snacks for exam day and watched a movie. Multiple times on test day I saw topics that I had very recently reviewed and was able to answer them quickly (and accurately), giving myself more time for conceptually challenging questions. My official USMLE Step 1 score was ultimately 254, 14 points higher than I’d scored on my most recent practice exams.
Kalyn Reddy is an MPH student at the Harvard School of Public Health, and a medical student at the Boston University School of Medicine. He tutors for Step 1, Step 2 CK, and Shelf Exams with USMLE Pro.